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Year : 2015  |  Volume : 25  |  Issue : 5  |  Page : 315-

Bouquet of flowers: Clue to medullary sponge kidneys

B Sureka1, K Bansal1, V Jain2, A Arora1,  
1 Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
2 Department of Renal Transplant and Urology, Institute of Liver and Biliary Sciences, New Delhi, India

Correspondence Address:
B Sureka
Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi 110 070
India

How to cite this article:
Sureka B, Bansal K, Jain V, Arora A. Bouquet of flowers: Clue to medullary sponge kidneys.Indian J Nephrol 2015;25:315-315

How to cite this URL:
Sureka B, Bansal K, Jain V, Arora A. Bouquet of flowers: Clue to medullary sponge kidneys. Indian J Nephrol [serial online] 2015 [cited 2021 Oct 26 ];25:315-315
Available from: https://www.indianjnephrol.org/text.asp?2015/25/5/315/150079

Full Text

A 19-year-old female was worked up for recurrent urinary tract infection. Ultrasonography revealed bilateral enlarged echogenic kidneys with simple cysts and focal caliectasis [Figure 1]. CT urography revealed cortical as well as medullary cysts, medullary calcifications, enlarged kidneys, and retention of contrast within the renal papillae giving a striated appearance with papillary blush pattern [Figure 2]. Based on the imaging findings, a diagnosis of medullary sponge kidney (MSK) was made.{Figure 1}{Figure 2}

Medullary sponge kidney is a sporadic condition characterized by congenital malformation of the precalyceal collecting tubules in the medullary and papillary portions of the kidneys. [1] The incidence of MSK is estimated at ≈1:5000.

Most cases of MSK are diagnosed during the workup of renal stones. However, a subset remains clinically silent, and the diagnosis is incidentally picked up on renal imaging for other indications. The strong association of MSK with nephrolithiasis, especially calcium stones, is explained by the tendency of urinary stasis in the ectatic collecting ducts.

On imaging, clusters of pyramidal medullary calcifications are diagnostic. Ultrasonography demonstrates echogenic medullary pyramids. Post-contrast delayed CT or intravenous pyelogram demonstrates a "paint brush" appearance or "bouquet of flowers" in the renal medullary regions due to pooling of contrast material within the dilated ectatic papillary ducts. Recognized associations with MSKs include Ehlers-Danlos syndrome, Caroli's disease, and Beckwith-Wiedemann syndrome.

Treatment of MSK is related to the management of associated metabolic abnormalities. Potassium citrate has been shown to be effective in reducing stone risk. [2]

References

1Koraishy FM, Ngo TT, Israel GM, Dahl NK. CT urography for the diagnosis of medullary sponge kidney. Am J Nephrol 2014;39:165-70.
2Fabris A, Lupo A, Bernich P, Abaterusso C, Marchionna N, Nouvenne A, et al. Long-term treatment with potassium citrate and renal stones in medullary sponge kidney. Clin J Am Soc Nephrol 2010;5:1663-8.